Tag Archives: Mental Health

I have been busy and have not posted for a while as we are selling our house. We have outgrown it and need to move to a larger home. It has been hectic, cleaning and presenting our house, viewing others, accepting and making offers, dealing with estate agents and solicitors. It all seems to be sorted, we have sold and we have somewhere to move to which is not bad given our house went on the market at Easter!

Moving house is cited as one of the most stressful things you can do in your life, beaten only by a death of a close one and divorce. Stress does funny things to people, I get butterflies in my stomach and find it hard to eat but I also find it quite energising. My husband gets very anxious and feels it somatically in his body as a pounding heart, tense shoulders and headaches. Anxiety is something he suffers with in many spheres of life. Looking at his relationship with his NPD mother helps explain why.

John Bowlby was a British psychotherapist who after the second world war researched the effects of being orphaned on children who were victims of the war. He developed a very influential paper on maternal deprivation for the United Nations and expanded this to a full theory of the emotional and psychological attachments formed by young children and the effects that they have on the child into adulthood. This is, hardly surprisingly, called Attachment Theory.

Attachment Theory Basics

The basic assumption of attachment theory is that a child needs to form a single, secure attachment to a loving and responsive caregiver (usually the mother) for the child to develop healthy emotional structures and ways of relating to others. Things that can disrupt this attachment would include being orphaned or separated from one’s mother, like during the war, or having an emotionally unavailable or abusive mother. You can see where I am going with this right?

Children form a particular pattern of behaviour as a result of the type of attachment they have with their main caregiver, I’ll just use “mother” from now on as I’m assuming like my husband your spouses were mostly cared for by their mum.

The most common attachment is a secure attachment that forms with a good enough mother, 60% of adults have this sort of attachment. The good enough mother hugs the child when they are distressed, mirrors their smiles and grimaces, makes lots of eye contact, strokes them, responds to their interactions and carries them close when they’re little. There is an approach to parenting babies called attachment parenting advocated by William Sears and others which encourages the key interactions that foster close, secure attachments. He advises skin to skin contact with newborns, lots of carrying and cuddles using slings if necessary, breastfeeding and eye contact and cuddles if bottle feeding, having the baby sleep close to the mother for 6 months, next to her bed within touching distance.

There is a lot of evidence that shows these sorts of interactions ensure the healthy, secure attachment forms. This then means the child grows up expecting their interactions with others to similarly be secure and they feel comfortable expressing their emotions and needs and responding to others emotions and needs. Thus the securely attached child forms healthy adult relationships and friendships with a good balance between independence and intimacy.

But not everyone has this secure pattern. There are other sorts of mothers with other kinds of interaction styles which lead to less healthy attachment patterns. There is an anxious pattern, an avoidant pattern and a fearful pattern. Some research has suggested a final ambivalent pattern of attachment formed by inconsistent caregivers. Mary Ainsworth carried out several experiments with children aged around 1 year old, small toddlers, which extended much of what Bowlby had described in war orphans.

The patterns of attachment in small children are best observed when they are confronted with new situations or their mothers leave them temporarily in a play group or similar setting. The securely attached child goes freely forwards and back to the mother, touching base and venturing forth. If the mother leaves they are upset and cry for her then show they are comforted when she returns.

An anxious child has a different reaction. They are clingy, find it hard to cope with their mother not there and need constant reassurance. Without the presence of their main attachment they are panicky and have no real security in themselves. What sort of behaviour from the mother creates this type of attachment? An excessively controlling, over-involved mother who doesn’t allow or encourage risk taking or the independence of the child.

An avoidant child doesn’t seem upset when their mother leaves and doesn’t show much comfort or pleasure when she returns. This child may even ignore their mother or turn away from her, not responding to being picked up by her. The child doesn’t feel much of a bond to the mother. The mother in this case is unresponsive to the child if they cry, in fact even discourages them from showing upset or distress and pushes them to be independent of her.

The fearful or disorganised child freezes or rocks when their mother returns, they try to approach her for comfort but are so unsure of the response they do this with their back turned or creep round the room to get to her. This is a hallmark of an overtly abusive mother. The child wants comfort from the person they fear.

Now there is a theory, not espoused by Bowlby himself who worked purely on children, but developed in the 1980s that adults can exhibit similar patterns of attachment in their adult romantic relationships. Cindy Hazan and Phillip Shaver spotted similarities between the ways adults react to the presence or absence of their romantic partners. In both situations the relationship with a person, the mother or lover, provides an opportunity for bonding and the enactment of expectations about the nature of close bonds that the adult has internalised through their previous close relationships. The most influential relationship in forming ideas and expectations about close emotional ties is the one we have with our main carer when we are small children, i.e. our mothers.

What if you are married or in a close relationship with a person whose mother has NPD? What sort of attachment behaviour will they have and how will it show itself in your relationship?

Attachment Theory and Adults

Having a mother with NPD means you could have any attachment pattern expect the secure one. Unless of course you weren’t actually raised by your mother but by another, psychologically normal person like an aunt or grandparent. You are reading this blog because your partner has a difficult (to say the least) mother who exhibits a lot of unpleasant and abusive behaviour. Your partner will not be fully secure and confident in their adult relationships unless they have done a lot of work on themselves in coming to terms with their family and its effects on them.

Hazan and Shaver described 4 patterns of adult attachment similar but not identical to the patterns of attachment in tiny children. They called them secure, anxious-preoccupied, dismissive-avoidant and dismissive-fearful.

Now my husband and I did an online test of adult attachment patterns http://www.web-research-design.net/cgi-bin/crq/crq.pl which is free and asks a series of questions where you choose your response on a scale of strongly agree to strongly disagree. I came out with a secure attachment style, not surprisingly as my main caregiver as a child was my good enough mother who gave hugs, played with me and responded appropriately to any distress or upset I showed. My husband has the anxious-preoccupied style. I am absolutely sure if my SIL did this same test she would be dismissive-avoidant.

How do these patterns show themselves in adult behaviour? My husband needs constant reassurance that we, our relationship, is OK. He needs me to act in ways that reassure him and he resists anything that makes him anxious, things that may hint at a distance between us or possible conflict or separation, not just physically but of ideas, views, aims and emotions. He cannot argue or tolerate my showing anger as this makes him so anxious. So he diverts the conversation away from the difficult topic onto something else, like my tone of voice (unpleasant) or blunt talk (can’t you phrase that nicely). He finds it very hard to deal with if I am unable to be there emotionally for him due to a crisis of my own. Postnatal depression a couple of years ago for a few months was the worst thing ever to happen to our relationship as far as he is concerned because I was not there for him.

The underlying dynamic involves his expectation that I will soothe his anxiety by modifying my behaviour or he will try to change my behaviour through control of some kind including passive aggressive acts, sulking, withdrawl, blaming, diversions etc. He sees his emotional regulation as being the job of an external person, the person he is bonded to. He is not clear where he ends and I start. This is entirely due to having an engulfing, controlling mother who expected him to cater to her moods and change himself for her. She dictated what emotions he could show and how he showed them. He people-pleases to ensure the continuation of the relationship thus avoiding his extreme anxiety at being abandoned or rejected.

His sister is dismissive-avoidant in her behaviour. She has had a series of unsuccessful relationships with unsuitable partners and works extreme hours, in a job involving extensive overseas travel making herself unavailable for long periods of time. When confronted with an emotional situation she shuts down. Told some upsetting news she failed completely to react, got down on the floor to play with her nieces as if nothing had been said. She avoids her own emotions and other peoples. Keeping others at arms length is normal for her. Her emotional regulation is to suppress and deny her emotions and needs for intimacy acting in a very independent and self-sufficient way.

Of course she had the same mother as my husband but she was the second child and so had less of her NPD mother’s attention, much less if her behaviour is anything to go by. She comments on how much fewer photos there are of her as a child compared to my husband and how she was given all his hand-me-down clothes. She was not the substitute spouse in the same way as my husband, my MIL was clearly overly involved with her son alternately infantalising him to keep him close and using him for emotional support.

Both these patterns have been described as pseudo-independent by Robert Firestone. True adult independence requires a complete sense of yourself as separate from others combined with a capacity to be fully able to emotionally connect with another at an appropriate time. It is all about balance. These two attachment patterns are unbalanced.

The final adult attachment pattern is dismissive-fearful and is shown in people who want, often desperately want a close bond but are scared of being hurt physically or emotionally by the object of their attraction. They fundamentally do not trust their partners and have doubts about their intentions as they have negative views about themselves. They ask “why are you attracted to me, what do you really want?”. This form of attachment in an adult can stem from sexual abuse as a child or teen or from a childhood with significant losses through the absence or rejection of a parent. Unlike a dismissive-avoidant person they are aware that they want closeness and intimacy but like dismissive-avoidant they act in a way that restricts intimacy and don’t share their emotions.

Which pattern does your spouse exhibit? I am interested to hear what sorts of attachments your spouses seem to have and how you think this may be related to their mother’s behaviour towards them.

I’m writing about communication this morning as I had been lying awake last night running a scenario over and over in my mind. The root cause of the scenario which will probably happen at the next MIL visit over the summer is her inability to communicate clearly and directly. I think problems with communication are common to all personality disorders.

Why do we communicate? I find it helps to consider small children when trying to understand communication. They start out just making noises and learn slowly how to shape the noises and gestures into meaningful interactions. Babies develop communication in a predictable way.

First they learn to communicate basic needs. They get hungry; they cry. They are cold; they cry. The purpose of crying is to alert the caregiver who will respond in an appropriate way to cater to the baby’s need. New parents take a while to learn and anticipate a baby’s needs and they cycle through the list of possibilities (hungry, tired, cold, hot, nappy, comfort etc) before hitting on the correct response. A good enough parent will keep going through the list until the child’s need is correctly identified.

The next stage of learning to communicate is mirroring. This time the parent leads the interaction. They see the faces the baby is making and makes them back. They repeat the gurgly baby noises and play lots of hiding and appearing games. Watch anyone with a newborn and they make a huge amount of eye contact and pull all sorts of goofy faces. This response to a baby is automatic and it is very important. Just like responding to cries secures the baby’s confidence that their needs will be met, copying their facial expressions and noises shows the baby what their emotions look like and gives them the confidence to express them. They are learning a vital emotional vocabulary. (The books “The Social Baby – Understanding babies’ communication from birth” by Lynne Murray and Liz Andrews, “The Science of Parenting” by Margot Sunderland and “Why Love Matters – How affection shapes a baby’s brain” by Sue Gerhardt go into this in some detail).

Then babies start to coordinate their bodies better and can point to things they want. Their first communication through gestures is “Look! That, that!” and then “I want that, give it to me”. They draw another’s attention to something in the environment (Look! That, that!) and then they express what they want (Gimme!). So being able to clearly express your desire for something to another is something people learn very early on, from about 9 months old.

People with personality disorders don’t do this. They are not able to clearly express their desire for something to another person. Not even a basic need such as hunger or being desperate for the loo. Let’s look at why that is and how it shows up in their behaviour.

Why can’t they ask for things clearly and directly?

The key to understanding this is the interaction between the baby and the caregiver. What if the caregiver doesn’t work through all the possibilities when the baby cries? What if they ignore the baby? What if the baby is not played with and mirrored in lots of face to face interactions? What if the baby is punished for expressing their needs? These are conditions of neglect. They are conditions where the baby’s early attempts at communication are rebuffed. It is not surprising then if a baby with a parent like this would develop communication problems.

Some academics believe NPD occurs because the early interactions between the main caregiver and the baby are dysfunctional from as early as 6 months old. This is one of the reasons why post natal depression is taken so seriously by the medical establishment. Without good interactions between baby and caregiver early on the whole developmental track of the child is disrupted.

Some babies will scan their environment seeking out another responsive adult, maybe the other parent or a grandparent or child minder or even a sibling. The drive inside the baby to find a responsive caregiver is very strong. They will do better than a baby which hasn’t got an alternative adult to respond to them or who has a weaker instinct to seek one out, that misfortunate child will never learn to communicate effectively or recognise their own emotions properly. That child may end up with a personality disorder. I qualify that sentence with “may” but really you could replace the word with “will” so strong is the link between adult dysfunction and disordered care in the very early years.

The end result is someone who is incompetent in expressing themselves and actually fearful of openly and clearly making their needs and desires known. If as a child your cry for comfort was ignored or responded to with shouting or a slap you would learn pretty damn quick not to do that, not to show directly that you wanted comfort. The need for comfort would still be there. The child would learn which ways that need could be met by the unresponsive or neglectful caregiver which inevitably would mean putting what the caregiver found acceptable ahead of the baby’s instinct. This is completely arse about face, the adult caregiver should put the baby’s needs first not their own. If never adequately met, the need would remain as an immature and insatiable drive in their psyche throughout their whole life. NPD is a need to be valued and loved which becomes utterly distorted into thinking oneself more valuable and more worthy of love than anyone else.

If the child is made to feel ashamed and ungratefully demanding when they express their needs they would grow into adulthood very wary of the response they may get when expressing a need. They would skirt around the edges of what they want, attribute the desire to another, always leave themselves with some get out clause from having the need directly attributed to them. This leads to indirect and confusing communication.

How does disordered communication show itself?

I have observed several patterns of behaviour that I have come across in adults with personality disorders. All these behaviours contribute to the communication problems people have when dealing with a persona with a PD. Here I discuss indirect speech, triangulation, proxy recruitment, mind-reading, ambiguity, unique vocabulary.

Indirect Speech: Instead of using active, first person vocabulary like “I want to go here” a more passive, third person voice is adopted “perhaps people would like to…” where it is unclear if this is the actual desire of the person involved of if they are simply hypothesising what another person’s desire may be.

Triangulation: the person uses a third party to convey a message to someone or find out information about someone. Examples: MIL talks to SIL about a topic she wants us to know about, relying on SIL mentioning it when SIL speaks to us. MIL conveys her desires through interactions with grandchild “would Mummy let you have more sweets grandchild?” rather than ask directly. I think “accidentally” copying you into an email to someone else which talks about you is also an example of triangulation.

Proxy recruitment: this is a more deliberately manipulative strategy than triangulation but still uses a third person to convey a message. Now the third person is recruited to act as a mouthpiece or foot soldier by the NPD person. Examples: Telling a relative how upset they are with someone’s behaviour and asking the relative to convey that to the person rather than telling them directly. Getting a subordinate to sack a member of staff or pass on bad news to management.

Mind-Reading: expecting other people to know things without being told. Example: not saying what they would like for their birthday when asked as they expect the other to know or acting as if they have said something when they haven’t because thinking the message is so strong in their own mind they assume somehow that others must know it too.

Ambiguity: This involves not specifying details in a conversation leaving others confused as to who or what is being alluded to. Lots of pregnant pauses, knowing looks, nudge-nudge non-verbal behaviour and use of words like someone, something, it, that, you know, thingy etc are used. Examples: “someone might get bored over the summer and … you know…”, “ever since the incident, she’s been a bit (eyebrows raised)…”.

Unique Vocabulary: This involves the NPD person having their own unique use for common words which mean something completely different to the usual meaning of the word. Examples: “I’m not making excuses” when they are offering an explanation for behaviour in such a way as to minimise or remove any consequence, which is of course exactly what is meant by making an excuse.

I think the fundamental problem with the communication of personality disordered people is their difficulty in recognising their own needs due to a lack of mirroring as babies and an inability to express them clearly due to fear of being rejected or punished.

What is so difficult for other people involved with a PD person is that their methods for communicating are confusing, unclear and unreasonable. There is another level of interaction that follows from the disordered communication which is the anger and punishment the PD person directs at others who don’t understand their communication.

They are unclear and indirect and then punish others for not understanding what they are failing to convey.

A personality disorder is what happens when someone is so fucked up as a child, a really small child, that they are unable to develop normally. The stages of personality development that we all pass through from mewling infant to autonomous adult are disrupted in someone with a personality disorder. This is not due to any innate problem with their brains, with the possible exception of antisocial personality disorder a.k.a. psychopathy, it is almost entirely due to having abusive parents. There is simply no getting around this. Sorry. It’s the parents’ fault.

The fucked up child becomes stuck at an early stage of personality development. Usually this stage is one that would normally passed through before the child is 5 years old or so. Due to the disordered nature of the child’s interactions with their parents they cannot progress beyond a certain stage and this immature mental age stays with them for their entire life causing no end of problems in their interactions with other human beings.

Children frozen at the Little Nero temper tantrum stage of development grow up narcissistic. Those who mature a little further and have learned some more socially acceptable strategies to get their own way develop histrionic personality disorder. Those who get frozen just as they reach out to take some ownership of their environment and the wider world develop anxious disorders. This freezing doesn’t mean the person acts like a child. The problem is far more profound than simply being about behaviour.

The person with a personality disorder is unable to understand other human beings. Just like a two year old truly doesn’t understand notions such as love, justice or sharing so the adult frozen at the emotional age of a two year old grows up fundamentally unable to understand these ideas. They see other people as a child would see them. As objects which move around and interact, providing for their needs or not but without having much clue about the other people’s inner life and motivations.

Theory of mind is the ability to attribute mental states such as intent, knowledge, desire, belief, to oneself and others and to understand that others have beliefs, desires, and intentions that are different from one’s own. People with personality disorders never developed a full theory of mind. So they are frozen with emotional needs and a theory of mind at a debilitatingly early stage.

On top of this immaturity is another layer of problems. When your very survival in the form of being adequately fed, cared for and nurtured as a small child depends on some people who themselves are not very mentally healthy you have to develop strategies pretty damn quick to make sure your unhealthy mum and dad don’t either attack you physically or emotionally or neglect you.

The defence strategies of a child in an abusive environment take several forms. There is defence in the form of managing their emotions. For example you may learn very early on not to cry as no one will come to comfort you, you may learn showing anger with the unhealthy parents is seriously disapproved of and so never raise your voice or look irritated. You may learn that showing fear delights the unhealthy parent and so present a completely neutral face even when terrified.

There is defence in the form of people-pleasing. You may learn that doing whatever your unhealthy parents want straight away gets you a quieter, nicer life. There is defence in adopting dysfunctional communication methods like triangulation, proxy recruitment or passive-aggressive ways of conveying messages. The most damaging defence however is to copy the unhealthy adults. That way the child ends up being abusive, not just receiving abuse. These defences against being abandoned and rejected by the unhealthy mum and dad remain frozen in the person with a personality disorder long after they have served their purpose.

So there is a double whammy; being mentally stuck at a really very immature stage in their way of being able to conceptualise other people and having developed and retained some very dysfunctional ways of relating to other people.

This is a pattern of behaviour that is with the personality disordered person their whole life and is evident from adolescence onwards. It is a pattern of behaviour that is sufficiently damaging so that it interferes with the career, relationships, family and daily function of the individual. It is not the result of a short term life event or source of stress such as bereavement or illness and is not, in the main, treatable. Bummer.